Gerard Karen, Lattimer Val
School of Nursing and Midwifery, University of Southampton, UK.
Fam Pract. 2005 Feb;22(1):28-36. doi: 10.1093/fampra/cmh623. Epub 2004 Nov 4.
A study was undertaken to investigate patients' strength of preferences for attributes or characteristics associated with delivery of emergency primary care services available during usual GP surgery hours and to investigate the trade-offs between attributes.
A discrete choice experiment was used to quantify patients' strength of preferences for several key attributes of usual-hours emergency primary care. The attributes were chosen to reflect the findings of previous research, current policy initiatives and discussions with local key stakeholders. A self-complete questionnaire was administered to NHS Direct callers and adult attenders at Accident and Emergency, GP services and the NHS Walk-in Centre in the locality. Regression analysis was used to estimate the relative importance to patients of the different attributes.
An overall response of 71% (n=432) was achieved. All but one of the attributes was a statistically significant predictor of preference. The attribute 'being kept informed about waiting time' was the most important. This was followed by 'quality of the consultation', 'having a consultation with a nurse', 'having a consultation with a doctor' and 'contacting the service in person'. Respondents were prepared to wait an extra 68 min to have a consultation with a doctor, but an extra 2 h 9 min for information about expected waiting time. There were no measurable preference differences between patients surveyed at different NHS entry points. Respondents younger than 45 years held strong preferences with respect to how they wanted to make contact with the system, whereas older respondents appeared not to hold strong preferences, seemingly indifferent between the alternatives. There was weak evidence which showed the younger group more strongly preferred accessing services via an integrated telephone system than making contact in person.
This study showed that local solutions for reforming emergency primary care during hours when the GP surgery is open should take account of the strength of patient preferences. The discrete choice method was acceptable, and the results directly informed the development of a local service framework for such care.
开展一项研究，以调查患者对与在全科医生正常出诊时间提供的紧急初级医疗服务相关的属性或特征的偏好强度，并研究属性之间的权衡取舍。
采用离散选择实验来量化患者对正常出诊时间紧急初级医疗服务的几个关键属性的偏好强度。所选属性反映了先前研究的结果、当前的政策举措以及与当地主要利益相关者的讨论。对拨打国民保健服务热线的人员以及当地事故与急救中心、全科医生服务机构和国民保健服务随到随诊中心的成年就诊者进行了自填式问卷调查。采用回归分析来估计不同属性对患者的相对重要性。
总体回应率为71%（n = 432）。除一个属性外，所有属性都是偏好的统计学显著预测因素。“随时了解等待时间”这一属性最为重要。其次是“咨询质量”“与护士进行咨询”“与医生进行咨询”以及“亲自联系该服务”。受访者愿意多等68分钟与医生进行咨询，但愿意多等2小时9分钟以获取预期等待时间的信息。在不同国民保健服务接入点接受调查的患者之间没有可测量的偏好差异。45岁以下的受访者对如何与该系统联系有强烈偏好，而年长的受访者似乎没有强烈偏好，对各种选择似乎无差异。有微弱证据表明，较年轻的群体比较喜欢通过综合电话系统获取服务，而不是亲自联系。
本研究表明，在全科医生诊所开放时间内改革紧急初级医疗服务的地方方案应考虑患者偏好的强度。离散选择方法是可接受的，其结果直接为这种护理的地方服务框架的制定提供了依据。
